Regional Director, Operations

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Job Description: ​

Candidates must be legally authorized to work in the United States without employer sponsorship, now or in the future.

The Regional Director of Operations has end-to-end operational accountability for planning, execution, and continuous improvement of market-level Risk Adjustment (BOI), Quality (HEDIS) and Cost of Care operation programs across multiple markets. This role owns operational processes, staffing, budgets, vendor relationships, data and technology enablement, and performance outcomes. The Director partners with platform BOI/Quality, Market Medical Directors, IT/Engineering, Data & Analytics, Finance and RBEs/providers to deliver compliant, scalable, and measurable operational performance.

This role requires travel 4–10 days per month to visit partner groups

Essential Job Functions:

Operational Leadership & Execution – 45%

• Lead and operationalize BOI, Quality and Cost of Care programs across 3+ markets; develop and enforce SOPs, SLAs and RACI for all program activities.
• Collaborate with Central Operations to manager operation, performance and outcomes related to pre-visit record review, post-visit coding review, chart collection, query workflows and provider engagement processes.
• In close partnership with the Market Leader and market operations team, oversee market operations, monitor performance, and implement corrective action and performance improvement plans.
• Define operational KPIs, run root cause analysis, lead process improvement efforts and institutionalize best practices across markets.
• Serve as the escalation point for market operational issues and lead cross-functional readiness for new initiatives.
• Provide oversight of operating budgets for BOI/Quality (labor, contractors, vendor spend); forecast resource needs and identify cost-to-serve improvements.

Data & Technology Ownership – 35%

• Partner with Data & Analytics and IT/Engineering to define technical requirements, data pipelines, EMR/claims integrations, and dashboards to support risk capture and quality improvement.
• In partnership with Tech, innovate on and participate in testing of solutions that drive automation and technology enablement to reduce manual effort and increase operational scale.

People & Capacity – 20%

• In collaboration with and informed by input from the Regional President, lead capacity planning, staffing models, recruitment, training and performance management for market BOI/Quality operations.

Required Qualifications:

Minimum Experience:

• 5+ years healthcare operations experience; 3+ years leading multi-market risk adjustment or quality programs

Education/Licensure:

• Bachelor’s degree required; advanced degree preferred
• Six Sigma/Lean certification preferred

Skills and Abilities:

• Solid knowledge of HEDIS, risk adjustment coding and healthcare data (claims/EMR)
• Demonstrated management of operational teams and vendor partners
• Analytics fluency (dashboards/KPI’s and either direct SQL or close collaboration with analytics teams)
• Proven program and project management skills and process improvement experience
• Language Skills: Strong communication skills both written and verbal to work with multiple internal and external clients in a fast-paced environment
• Mathematical Skills: Ability to work with mathematical concepts such as probability and statistical inference.  Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Reasoning Ability: Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems. 
• Computer Skills: Ability to create and maintain documents using Microsoft Office (Word, Excel, Outlook, PowerPoint)

Essential Physical Functions:

These are requirements normally expected to perform regular job duties. Incumbent must be able to successfully perform all the functions of the job with or without accommodation.

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Pay Range: ​

Salary range shown is a guideline. Individual compensation packages can vary based on factors unique to each candidate, such as skill set, experience, and qualifications.